This week’s coding tip focuses on the root operations restriction and occlusion in PCS coding. This can sometimes be challenging for coders when trying to determine the appropriate root operation (objective of procedure) to use. The onus is on the coder to determine what the physician performed based on the documentation in the record. Physicians are using restriction/occlusion and other procedure titles when performing procedures making it imperative that the coder review the entire procedure note.

Restriction:

The root operation “restriction” is used when the surgeon partially closes (partial occlusion) an orifice or the lumen of a tubular body part. The tubular body parts are defined in ICD-10-PCS as those hollow body parts that provide a route of passage for solids, liquids, or gases. The objective of these procedures is to narrow the diameter and includes both intraluminal and extraluminal methods for narrowing the diameter.

Examples of Restriction:

Gastroesophageal fundoplication

Cervical cerclage

Banding of pulmonary artery using extraluminal device

Clipping of cerebral aneurysm (don’t want to completely close off)

Placement of restrictive stent in right lacrimal duct

Laparoscopic banding for obesity

Endovascular AAA repair with/without device

Occlusion:

The root operation “occlusion” is used when the surgeon completely closes an orifice or the lumen of a tubular body part. The objective of these procedures is to close off a tubular body part or orifice and includes both intraluminal and extraluminal methods for occlusion/closure.

If PCS contains a specific body part for anatomical subdivision of a body part “resection” would be used when all of the body part is cut out or off. (Lobectomy of RUL would be coded as a resection if all the RUL is removed even though the entire right lung was not removed).

Happy Coding!

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.